Provider Demographics
NPI:1861652380
Name:WILLIAMSON, CHARLENE T (MA, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:T
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ETTA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-5619
Mailing Address - Country:US
Mailing Address - Phone:225-939-7205
Mailing Address - Fax:
Practice Address - Street 1:625 S BURNSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3400
Practice Address - Country:US
Practice Address - Phone:225-437-9535
Practice Address - Fax:225-647-3704
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist